Classification of drug-related problems with new prescriptions using a modified PCNE classification system
- 855 Downloads
- 21 Citations
Abstract
Objectives To explore and classify drug-related problems (DRPs) with new prescriptions detected in community pharmacies using a modified PCNE (Pharmaceutical Care Network Europe) classification system. Setting Sixty-four Swiss community pharmacies offering internships for pharmacy students. Main outcome measures Occurrence, nature and pharmacist’s management of DRPs. Methods Fifth-year pharmacy students collected consecutively hospital discharge and primary care prescriptions. After training, they documented clinical and technical DRPs, causes and interventions. Results Prescriptions of 616 patients (43.0% discharged from hospital) were analysed. The patients’ median age was 56 years and they received a median of 3 (range 2–19) different drugs. In 121 (19.6%) prescriptions 141 clinical DRPs were detected. The most frequent clinical DRPs were potential drug–drug interactions (DDIs) (37.6%), drug choice (24.8%) and drug use problems (15.6%). These clinical DRPs led to a total of 299 interventions. There were 222 prescriptions (36.0%) that showed 278 technical DRPs, resulting in a total of 417 interventions. Most frequent technical DRPs were missing or unclear package size or therapy duration (32.7%) and missing or unclear dosing/application instructions (30.9%). Most DRPs (75.4%) could be managed by the pharmacist alone. The number of prescribed drugs was the main factor with an influence on the frequency of clinical and technical DRPs. Conclusion Clinical and technical DRPs are frequently observed in primary care as well as in hospital discharge prescriptions. The modified PCNE classification system, especially the amendment with a technical DRP category, proved to be useful and allowed the classification of all DRPs. Neither the setting (hospital discharge vs. primary care) nor the quality of electronically printed prescriptions, but only the number of prescribed drugs influenced the occurrence of clinical or technical DRPs.
Keywords
Classification system Community pharmacy Drug-related problems Hospital discharge PCNE Pharmaceutical care Primary care SwitzerlandNotes
Acknowledgements
We would like to thank the owners of the 64 participating pharmacies and Michael Mittag for the support in statistical analysis.
Funding
No funding was provided for this Ph.D. student research.
Conflicts of Interest
None.
References
- 1.Westerlund LT, Almarsdottir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7(11):40–50.Google Scholar
- 2.Ernst ME, Iyer SS, Doucette WR. Drug-related problems and quality of life in arthritis and low back pain sufferers. Value Health. 2003;6(1):51–8.CrossRefPubMedGoogle Scholar
- 3.Triller DM, Clause SL, Briceland LL, Hamilton RA. Resolution of drug-related problems in home care patients through a pharmacy referral service. Am J Health Syst Pharm. 2003;60(9):905–10.PubMedGoogle Scholar
- 4.Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26(6):353–60.PubMedGoogle Scholar
- 5.Hammerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41(11):1825–32.CrossRefPubMedGoogle Scholar
- 6.Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007;30(5):379–407.CrossRefPubMedGoogle Scholar
- 7.Howard R, Avery A, Bissell P. Causes of preventable drug-related hospital admissions: a qualitative study. Qual Saf Health Care. 2008;17(2):109–16.CrossRefPubMedGoogle Scholar
- 8.Krahenbuhl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharm World Sci. 2008;30(6):777–86.CrossRefPubMedGoogle Scholar
- 9.Lampert ML, Kraehenbuehl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. Pharm World Sci. 2008;30(6):768–76.CrossRefPubMedGoogle Scholar
- 10.Patel P, Zed PJ. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy. 2002;22(7):915–23.CrossRefPubMedGoogle Scholar
- 11.Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug-drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–51.CrossRefPubMedGoogle Scholar
- 12.Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30(10):926–40.CrossRefPubMedGoogle Scholar
- 13.Smith CP, Christensen DB. Identification and clarification of drug therapy problems by Indian health service pharmacists. Ann Pharmacother. 1996;30(2):119–24.PubMedGoogle Scholar
- 14.Blix HS, Viktil KK, Reikvam A, Moger TA, Hjemaas BJ, Pretsch P, et al. The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol. 2004;60(9):651–8.CrossRefPubMedGoogle Scholar
- 15.Viktil KK, Blix HS, Moger TA, Reikvam A. Interview of patients by pharmacists contributes significantly to the identification of drug-related problems (DRPs). Pharmacoepidemiol Drug Saf. 2006;15(9):667–74.CrossRefPubMedGoogle Scholar
- 16.Shalansky S, Nakagawa R, Wee A. Drug-related problems identified and resolved using pharmaceutical care versus traditional clinical monitoring. Can J Hosp Pharm. 1996;49(6):7.Google Scholar
- 17.Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother. 2004;2(1):3–13.CrossRefPubMedGoogle Scholar
- 18.Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients’ problems with new medication for chronic conditions. Qual Saf Health Care. 2004;13(3):172–5.CrossRefPubMedGoogle Scholar
- 19.PCNE. The PCNE Classification V 5.01 2006 29 May 2006 [cited 20 Sep 2009]. Available from: http://www.pcne.org/dokumenter/DRP/PCNE%20classification%20V5.01.pdf.
- 20.Hersberger K, Botomino A, Sarkar R, Tschudi P, Bucher H, Briel M. Prescribed medications and pharmacy interventions for acute respiratory tract infections in Swiss primary care. J Clin Pharm Ther. 2009;34(4):387–95.CrossRefPubMedGoogle Scholar
- 21.AbuRuz SM, Bulatova NR, Yousef AM. Validation of a comprehensive classification tool for treatment-related problems. Pharm World Sci. 2006;28(4):222–32.CrossRefPubMedGoogle Scholar
- 22.Westerlund LT, Marklund BR, Handl WH, Thunberg ME, Allebeck P. Nonprescription drug-related problems and pharmacy interventions. Ann Pharmacother. 2001;35(11):1343–9.CrossRefPubMedGoogle Scholar
- 23.Eccles M, Grimshaw J, Campbell M, Ramsay C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003;12(1):47–52.CrossRefPubMedGoogle Scholar
- 24.Allenet B, Bedouch P, Rose FX, Escofier L, Roubille R, Charpiat B, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28(4):181–8.CrossRefPubMedGoogle Scholar
- 25.Knapp KK, Katzman H, Hambright JS, Albrant DH. Community pharmacist interventions in a capitated pharmacy benefit contract. Am J Health Syst Pharm. 1998;55(11):1141–5.PubMedGoogle Scholar
- 26.Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of interventions of prescriptions in Flemish community pharmacies. Pharm World Sci. 2003;25(2):65–9.CrossRefPubMedGoogle Scholar
- 27.Schaefer M. Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc. Pharm World Sci. 2002;24(4):120–7.CrossRefPubMedGoogle Scholar
- 28.Benrimoj SI, Langford JH, Berry G, Collins D, Lauchlan R, Stewart K, et al. Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance. Pharmacoeconomics. 2000;18(5):459–68.CrossRefPubMedGoogle Scholar
- 29.Currie JD, Chrischilles EA, Kuehl AK, Buser RA. Effect of a training program on community pharmacists’ detection of and intervention in drug-related problems. J Am Pharm Assoc (Wash). 1997;NS37(2):182–91.Google Scholar